All acute and chronic shoulder injuries should be treated using the P.R.I.C.E. therapy principles of protection, rest, ice, compression, and elevation. This should be applied at home for at least the first 2 - 3 days.
- Protection - Protect the injury from further damage. Where applicable, use of an arm sling or elbow support is recommended.
- Rest - Refrain from using the arm/elbow.
- Ice - The topical application of ice or cold therapy to the area of the injury can assist in reducing the symptoms of pain and inflammation.
- Compression - The use of a compression support to the arm or elbow can help reduce swelling.
- Elevation - Keeping the hand elevated above heart level whenever possible to help reduce swelling in the hand due to the effects of gravity. This is best achieved using an upper arm sling
Protection of the damaged tissue is vital to prevent further damage and enable the healing process to start efficiently and effectively. There are a number of ways to protect the injured area, all with the aim of limiting further movement. One way this can be achieved is by using a sling or splint.
In the early stages, rest is one of the most important components of the P.R.I.C.E principle but is often neglected or ignored. It does not only refer to the prolonged period of time that the athlete will be out of action but also to the immediate period after the injury.
An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer. If an injury is sustained during sporting activity some athletes have a tendency to 'run it off' or continue using the injured area. This implies that by continuing to participate in the exercise, the injury will simply go away. In fact, in the majority of cases, this is not true and is not advisable.
Cold therapy (cryotherapy) is one of the most widely known and used treatment modalities for acute sports injuries. It is cheap, easy to use and requires very little time to or expertise to prepare. The application of ice to an injury, in the acute phase, can substantially decrease the extent of the damage. It achieves this in a number of different ways.
- Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction)
- Reduces pain (pain gate theory)
- Reduces muscle spasm
- Reduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism
Ice is usually applied to the injured site by means of a bag filled with crushed ice which is wrapped in a damp towel. The damp towel is essential as it forms a barrier between the bag of ice and the skin and reduces the risk of an “ice burn”. DO NOT leave the ice on for more than 15 minutes as you could cause an “ice burn”.
There are a small number of areas that you should not apply ice to which include the neck, the outside bone of the elbow, the collarbone (upper end), the front of the hip (bony part) and the outer bone of the knee. The reason for this is there is a superficial nerve just below the skin in these areas that can be damaged by applying ice to it. Always check for contraindications.
Applying compression to an injured area minimises the amount of swelling that forms after an injury and should be applied for the first 24 to 72 hours from the onset of injury. Compression is not quite so easy on the shoulder joint but an elastic bandage can be used to wrap and support the shoulder joint in the early stages.
Elevation of the hand is the final principle of PRICE but is equally as important as the other 4. Elevation allows gravity to drain the fluid (oedema) away from the hand that is distal to the injury site (elbow).